Citation Nr: 1013909
Decision Date: 04/13/10 Archive Date: 04/29/10
DOCKET NO. 08-11 878 ) DATE
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On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO) in
Boston, Massachusetts
THE ISSUES
1. Entitlement to service connection for a skin disorder.
2. Entitlement to an increase in a 10 percent rating for
blepharitis.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
S. D. Regan, Counsel
INTRODUCTION
The Veteran had active service from June 1944 to June 1946.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a June 2006 RO rating decision that
denied service connection for a skin disorder (actinic
keratoses, to include as secondary to sun exposure), and
denied an increase in a 10 percent rating for blepharitis.
Please note this appeal has been advanced on the Board's
docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A.
§ 7107(a)(2) (West 2002).
The appeal is REMANDED to the RO via the Appeals Management
Center (AMC), in Washington, DC. VA will notify the
appellant if further action is required.
REMAND
The Board finds that there is a further VA duty to assist the
Veteran in developing evidence pertinent to his claims.
38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2009).
As to the Veteran's claim for service connection for a skin
disorder, the Board observes that his service treatment
records show that he was treated for skin problems on
occasions during service. Although not dated, there are
notations that the Veteran was treated for hives and for a
rash. There was also a notation that he was treated for a
fungus on his hand. The June 1946 separation examination
report included a notation that the Veteran's skin was
normal.
Post-service private treatment records show treatment for
variously diagnosed skin problems.
For example, a September 1991 treatment entry from G. A.
Dobecki, M.D., related an impression of tinea corporis. An
October 1991 entry also noted that the Veteran had tinea
corporis. September 1992 and May 1998 entries indicated
impressions of actinic keratosis. A treatment entry,
apparently dated in May 2001, noted an impression of rosacea.
A skin diseases examination for the VA (performed by QTC
Medical Services) noted that the Veteran reported that he
developed tinea on his arms and toes in 1944, and that he had
suffered from a persistent rash since that time. The Veteran
indicated that he was diagnosed with rosacea in 1990 and that
he thought it was related to his history of sun exposure
during his period of service. He stated that he had
precancerous skin lesions removed in 1990. The Veteran
indicated that he had been suffering from tinea, rosacea, and
actinic keratoses and that those conditions had existed since
1944. He remarked that due to his skin condition, he had
itching and he described his symptoms as occurring
constantly. The Veteran stated that his skin disease
involved areas that were exposed to the sun, including his
face, hands, and neck. The diagnosis was actinic keratoses
secondary to sun exposure. The examiner indicated that
rosacea and tinea were inactive. The examiner reported that
the Veteran's subjective factors were flaking and itching of
the skin and that his objective factors were multiple plaques
on the hands, face, and back.
The Board observes that there is no indication that the
examiner reviewed the Veteran's claims file. Additionally,
although the examiner commented that the Veteran had actinic
keratoses secondary to sun exposure, he did not specifically
relate any diagnosed skin problem to the Veteran's period of
service.
An October 2006 statement from Dr. Dobecki, M.D., reported
that he had seen the Veteran on numerous occasions since
1991. Dr. Dobecki indicated that he had primarily treated
the Veteran for actinic keratoses in sun exposed areas of the
head, neck, and upper extremities. It was noted that all of
the actinic keratoses had been treated with liquid nitrogen
cryosurgery simply because they were premalignant. Dr.
Dobecki reported that those sorts of lesions would take
decades to form after extensive sun exposure so that the
Veteran would not have had them after sunburns sustained in
the 1940s, but perhaps twenty or more years later. Dr.
Dobecki commented that, therefore, the reason for denial of
the Veteran's claim that he did not have those lesions while
he was on active duty was not a valid one.
The Board notes that there is no indication that Dr. Dobecki
reviewed the Veteran's claims file in providing his opinion.
The Board also observes that Dr. Dobecki specifically stated
that the Veteran's lesions (actinic keratoses) would not
occur after sunburns sustained in the 1940s, but perhaps
twenty or more years later. The Board notes, however, that
the record does not indicate any treatment for actinic
lesions until the 1990s, decades after the Veteran's period
of service.
The Board observes, therefore, that the Veteran has not been
afforded a VA examination with the opportunity to obtain a
responsive etiological opinion, following a thorough review
of the entire claims folder, as to his claim for service
connection for a skin disorder. Such an examination should
be accomplished on remand. 38 C.F.R. § 3.159(c)(4).
As to the Veteran's claim for an increased rating for
blepharitis, the Board observes that he was last afforded an
eye examination for the VA (performed by QTC Medical
Services) in September 2005. The examiner reported that the
Veteran did have some redness of the edge of his eyelids
indicating a mild blepharitis. The examiner also commented
that the Veteran's mild blepharitis was due to some chronic
skin disease, i.e., acne rosacea and squamous blepharitis.
The Board notes that the Veteran has received treatment for
his service-connected blepharitis subsequent to the September
2005 eye examination for the VA (performed by QTC Medical
Services).
For example, a July 2006 statement from R. T. Lacy, M.D.,
reported that in July 2006, he saw the Veteran for an
evaluation of his chronic blepharitis. Dr. Lacy stated that
the Veteran had suffered three flare-ups in the past six
months with inflamed, swollen, and reddened lid margins, and
with conjunctival injection. Dr. Lacy indicated that the
Veteran could usually maintain some control over his
condition with lid hygiene, lid scrubs, baby shampoo, and hot
compresses, but when there was a flare-up, Blephamide drops
would help. Dr. Lacy reported that, at the present time,
things seemed to be under fairly good control.
The Board observes that the Veteran has not been afforded a
VA examination as to his service-connected blepharitis in
over four and a half years. Additionally, the record clearly
raises a question as to the current severity of his service-
connected blepharitis. Further, the Veteran's representative
has specifically requested that the Veteran be scheduled for
an additional VA eye examination. Therefore, the Board finds
that a current examination is necessary. See Caffrey v.
Brown, 6 Vet. App. 377, 381 (1995) (VA was required to afford
a contemporaneous medical examination where examination
report was approximately two years old); see also Green v.
Derwinski, 1 Vet. App. 121, 124 (1991).
Prior to the examinations, any outstanding records of
pertinent treatment should be obtained and added to the
record.
Accordingly, these issues are REMANDED for the following:
(Please note, this appeal has been advanced on the Board's
docket pursuant to 38 C.F.R. § 20.900(c) (2009). Expedited
handling is requested.)
1. Ask the Veteran to identify all
medical providers who have treated him
for skin problems and eye problems since
October 2006. After receiving this
information and any necessary releases,
contact the named medical providers and
obtain copies of any outstanding records
of pertinent medical treatment which are
not already in the claims folder.
2. Schedule the Veteran for a VA
examination by a physician to determine
the nature and likely etiology of his
claimed skin disorder. The claims folder
must be provided to and reviewed by the
examiner in conjunction with the
examination. The examiner should diagnose
all current skin disorders. Based on a
review claims file, examination of the
Veteran, and generally accepted medical
principles, the examiner should provide a
medical opinion, with adequate rationale,
as to whether it is as at least as likely
as not (50 percent or greater probability)
that any diagnosed skin disorders are
etiologically related to his periods of
service. All opinions must be supported a
complete rationale in a typewritten
report.
3. Schedule the Veteran for a VA
examination to determine the severity of
his service-connected blepharitis. The
claims folder must be provided to and
reviewed by the examiner in conjunction
with the examination. All indicated tests
should be conducted and all signs and
symptoms of the Veteran's blepharitis
should be reported in detail, including
all information necessary for rating the
condition under Diagnostic Code 6018. All
opinions must be supported a complete
rationale in a typewritten report.
4. Thereafter, review the Veteran's
claims for entitlement to service
connection for a skin disorder and
entitlement to an increase in a 10 percent
rating for blepharitis. If any benefit
sought remains denied, issue a
supplemental statement of the case to the
Veteran, and provide an opportunity to
respond, before the case is returned to
the Board.
The Veteran has the right to submit additional evidence and
argument on the matter the Board has remanded. Kutscherousky
v. West, 12 Vet. App. 369 (1999).
No action is required of the appellant until further notice.
However, the Board takes this opportunity to advise the
appellant that the conduct of the efforts as directed in this
remand, as well as any other development deemed necessary, is
needed for a comprehensive and correct adjudication of his
claim. His cooperation in VA's efforts to develop his claim,
including reporting for any scheduled VA examination, is both
critical and appreciated. The appellant is also advised that
failure to report for any scheduled examination may result in
the denial of a claim. 38 C.F.R. § 3.655.
This claim must be afforded expeditious treatment. The law
requires that all claims that are remanded by the Board of
Veterans' Appeals or by the United States Court of Appeals
for Veterans Claims for additional development or other
appropriate action must be handled in an expeditious manner.
See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007).
_________________________________________________
A. C. MACKENZIE
Acting Veterans Law Judge, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Appeals for Veterans Claims. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (2009).